Have you ever been arrested for DUI/DWI before?

yes

no

If 'yes', what approximate date(s) was(were) your previous DUI/DWI(s)?

Date of Your Current Arrest?

Was your license valid on this most current arrest (ie. not suspended or revoked for another reason)?

yes

no

Did the officer take your driver's license and give you temporary license?

yes

no

Approximately how many minutes went by from the time the officer stopped/contacted you until he put the handcuffs on you?

Approximately what time were you first contacted by the officer?

Approximately what time you were arrested (handcuffed)?

Approximately how many minutes went by from the time you were arrested (when they handcuffed you) until you arrived at the blood, breath or urine test location?

Approximately how many minutes went by from the time you arrived at the chemical test location until you took the first chemical test (blood, breath or urine test)?

Did the officer see you driving, or if s/he did not, did you admit to driving a vehicle?

yes

no

I don't know/not applicable

Did the officer have a valid reason for stopping you in the vehicle?

yes

no

I don't know/not applicable

What did the officer indicate to you as the reason for the traffic stop or contact with you (check all that apply)?

SpeedingWeavingInvolved in accident - no injury to anyoneInvolved in accident - injury to at least one personRoadblock / checkpointUnkownS/he didn't tell me

If none of the above apply, please indicate the reason for the stop of your vehicle or contact with you?

Did you drink any alcoholic beverages, and/or take any drugs, within 10 hours of being stopped by the officer?

yes

no

I don't know/not applicable

If you drank alcoholic beverages, what type (highlight all that apply)?

None consumedBeer-regularBeer-microbrewBeer-malt liquorWine-redGinVodkaRumTequilaMartiniLong island ice teaOther

If 'Other', please indicate type of beverage?

Think about the drinks you had. Many people underestimate how many drinks they had, or cannot remember. This can be extremely important to your case though. In order to calculate your Blood Alcohol Level please indicate how many drinks you had total (one drink is equal to a 12 ounce beer, a regular 4 ounce glass of wine, or, 1 shot or 1 ½ ounces-of hard liquor)?

Number of servings of alcohol:

Approximately what time did you finish your LAST alcoholic beverage?

If you were on prescription medications or other drugs, what type (highlight all that apply)?

Not applicableAnti-depressantPain medicationValium/tranquilizerMarijuanaMethamphetaminePowdered cocaine'Crack' cocaineHeroinEcstasyOther

If 'Other', please indicate type of medication or drug?
 

What size meal did you have within three (3) hours of drinking or drug use?
Not SelectedHadn't eaten within the time limitBar snacksSmall mealMedium mealLarge mealExtremely large mealOther

If 'Other', please indicate size of meal?

Did you feel the effects of the alcohol you drank, or drugs you were taking, when you were driving (i.e. feel a buzz, feel drunk or high)?

yes

no

I don't know/not applicable

If you drank after driving, please explain:

Did you take any field balance/coordination (field sobriety tests - FST's) tests prior to being arrested and handcuffed?

yes

no

I don't know/not applicable

Were you ordered or did you do them voluntarily?

Ordered

Voluntary

Please select the field sobriety tests you were ordered to perform (check all that apply)? Did not take any field testsFollow a pen, finger, or other object with your eyesStanding with my head titled back and eyes closed, feet togetherStanding on one foot for a period of timePatting your hands togetherCounting on your fingersSaying or writing the ABC'sWalking a straight line, or heel-to-toeTouching your nose with fingerOther

If 'Other', please indicate what they made you do?

Did you blow into a field breathalyzer or hand-held type gadget?

yes

no

If you know, what was the result of the hand-held breathalyzer gadget test?

Did the officer advise you that you could refuse to take the hand-held gadget breath test?

yes

no

I don't know/not applicable

Did you fail to satisfactorily perform the balance and coordination tests as demonstrated to you by the officer?

yes

no

I don't know/not applicable

Did you take a blood, breath or urine test?

yes

no

I don't know/not applicable

If you took a chemical test, did you take a blood, breath, or urine test?

Blood

Breath

Urine

I don't know/not applicable

Did you take the chemical test (blood, breath or urine at the station) within 2 hours of driving?

yes

no

I don't know/not applicable

Did you select (choose for yourself) the chemical test if you took at least one (i.e. the blood, breath, or urine test)?

yes

no

I don't know/not applicable

If 'yes' type in the test and the results if you know:

If you are charged with refusing a chemical test, where or when did you supposedly refuse? Not SelectedI took the chemical testS/he told me I would have my license suspended if I refused, and I refused anyway.I refused during the initial vehicle stop or contact with the cop.I refused when they handcuffed me.I refused in the patrol car.I resused in the patrol car, on the ride to the chemical test location.I refused at the chemical test location.I refused everything from the beginning.I refused when he first stopped me.I refused when we were doing the field tests.I refused when at the station, but he didn't tell me I would loose my license if I refused.S/he told me I could refuse the test when he used a hand-held breathalyzer, so I did.S/he never told me I had to take a test and he didn't tell me I would loose my license for refusing.
 

If you refused, but later changed your mind, please give details:

What type of law enforcement officer was the arresting officer (the one who gave you tests, handcuffed you, took you to jail)?
Not SelectedHighway Patrolman/TrooperLocal Sheriff DeputyCity Police OfficerOther Law Enforcement Officer

Please input the arresting officer's last name and badge or serial number:

Please input the agency that the officer worked for (ie. San Francisco Police Department):

Did the officer treat you fairly and professionally?

yes

no

Please enter any comments about the officer below:

City and State where arrest took place?

In which County Court are you scheduled to appear?

What date and time is your court date?

Please enter any comments or things you think your attorney should know that is not asked for on questionnaire:

Have you consulted with another attorney?

yes

no

Is it your goal to win your DUI case?

yes

no

Is it your goal to save your Driver's License from suspension/revocation?

yes

no

Are you aware that DUI/DWI cases can be successfully defended?

yes

no

Are you aware that a conviction and/or driver's license suspension for DUI will result in insurance cancellation or an increase cost?

yes

no

 

Name: * 

Email Address:  

Your Home Address:  

Your ZIP code: * 

Primary Phone: * 

Secondary Phone:

Cell Phone:

Facsimile Number:

Contact Preference (when is the best time to contact you)? *

Date of Birth:

Driver License Number:

Occupation:

Annual Income:

Place of Employment:

What is your budget to defend your current case?

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